Thousands of people are facing the prospect of further surgery after a medical company recalled more than 17,000 artificial hips which had already been fitted .

Patients given the replacement are now being tested to see how many need fresh surgery after a design fault was found.

Sulzer Orthopaedics , which makes the hip, says only a small number of people will need a second artificial hip - the rest will be asked to go for regular tests.

Most of the replacements were sold in the US after October 1999 although a small number from July 1997 are included in the recall.

Approximately 17,500 products from the affected lots have been implanted, around 90% of those in the US.

Tests have shown that manufacturing oil has contaminated the hips which reacts with a patient's body, loosening the fit.

Patient Lindsay Low, who had received one of the artificial hips, said: "Recalls are supposed to be for tyres or something. They're really not supposed to be recalling things inside people."

At San Francisco's Summit Hospital doctors have already identified 254 patients who received the recalled hip.

Dr Mac Reynolds said: "Surgeons are not going to remove every one of the recalled hips. Patients not experienecing pain will be x-rayed every three months. Those who do have pain, we recommend replacing the hip."

When ABC News confronted Texas-based Sulzer Orthopaedics with the case of one woman who suffers constant pain from her replacement, the company issued an apology.

A spokesman said: "We have accepted full responsibility for this. We're profoundly disturbed by the effect the recall has had on the surgeon as well as the patient. And we're sorry for that."

The consultant who first raised concerns about MMR vaccinations has disclosed to The Telegraph that he has identified nearly 170 cases of a new syndrome of autism and bowel disease in children who have had the triple-dose injection .

Andrew Wakefield, a consultant gastroenterologist at the Royal Free Hospital in London, said that in the "majority" of cases parents had documentary evidence that their child's physical and mental decline had followed the vaccination.

Professor Wakefield said: "Last week in our clinic we saw nine or 10 new children with exactly the same story, referred by jobbing paediatricians from around the country who said, 'This child developed normally, had a reaction to MMR and is now autistic'".

In his first public comments since the row erupted in 1998, when he reported on 12 cases, Professor Wakefield said that he remained seriously concerned by the safety of the vaccine, despite reassurances from the Department of Health.

He said: "The department says that the safety of MMR has been proven. The argument is untenable. It cannot be substantiated by the science. That is not only my opinion but increasingly the view of healthcare professionals and the public.

He said: "Tests have revealed time and time again that we are dealing with a new phenomenon. The Department of Health's contention that MMR has been proven to be safe by study after study after study just doesn't hold up. Frankly, it is not an honest appraisal of the science and it relegates the scientific issues to the bottom of the barrel in favour of winning a propaganda war."

The doctor, who was fiercely attacked by health officials for voicing his doubts three years ago, said in an exclusive interview that he felt driven to break his silence because of the accumulating evidence. His remarks will infuriate the Government and sharpen the dilemma of parents over whether to have children innoculated with MMR.

It emerged last month that a rising number of doctors and nurses were worried about giving second doses of the vaccine, and pressure is growing for its separation into its three component vaccinations, spread over three years. In his 1998 article in The Lancet, Professor Wakefield reported finding a devastating combination of bowel disease and autism in 12 children.

His revelation that that figure has reached almost 170 cases will shock parents and doctors and add pressure on the Government to justify its vaccination policy. This month Dr David Salisbury, the head of the Government's immunisation programme, insisted that MMR was safe.

The vaccine, which contains live measles, mumps and rubella virus, has been given to millions of children in the UK since its introduction in 1988 but the take-up rate has fallen sharply since Dr Wakefield made his original claims.

Ten days ago health chiefs warned parents that Britain could face a measles outbreak unless more had their children vaccinated with MMR. Professor Wakefield said, however, that if an outbreak were to erupt it would be the fault of the health department, which had "failed to address the safety issues".

The doctor and his colleagues are testing the hypothesis that the measles virus from the vaccine can lodge in the gut of susceptible children, damaging the bowel and causing autism, and that the addition of the mumps virus makes that more likely.

21 Jan 01 - Medicine - The case against MMR

One of the fundamental rules of medicine is to listen to your patients because the clues to their disease lie in their story. If you forget that rule, it is time to leave the ward.

In 1995 I was approached by parents - articulate, well-educated and concerned - who told to me the stories of their children's deterioration into autism. The children had developed normally for the first 15 to 18 months of life when they received the MMR vaccination. But after a variable period the children regressed, losing speech, language, social skills and imaginative play, and descending into autism.

The parents described developmental regression in a normally developing child, bowel symptoms the severity of which appeared to parallel the behavioural problems, and an association with the MMR vaccination.

The parents said their children had a bowel disease underling their autism. They were right. The pain, diarrhoea and abdominal bloating suffered by their children, often for many years, reflected a novel and characteristic inflammatory bowel disease. The initial findings, published in the Lancet, were so consistent and so unexpected they merited publication in their own right.

A detailed follow up study was published last October in the American Journal of Gastroenterology confirming the presence of a new bowel disease in these children.

The number of autistic children investigated stands at more than 170; our waiting list grows by the day.

Parents who had raised concerns with their child's paediatrician or vaccine experts at the Department of Health were told it was "coincidence". MMR is given in the second year of life when the symptoms of autism are often first noticed by parents. Doctors had not listened. What the parents described was not classical autism but regression in a previously normal child accompanied by symptoms of systemic disease.

Since 1995 my colleagues and I have reviewed all of the available studies of measles and MMR vaccine safety. Our analysis of pre-licensing trials of MMR shows they were inadequate.

The success of vaccination programmes depends upon trust and the loss of trust has the potential to compromise vaccination strategies. The DoH's decision to withdraw the license for importation of monovalent measles vaccine was wrong. If protection against measles is a principal concern, surely it is important to allow parents to use the monovalent vaccines when they are concerned - rightly or wrongly - about the safety of MMR. The public must be offered a choice. For MMR, autism, and inflammatory bowel disease, suspicion exists without adequate evidence of safety. While doubts remain - give parents a choice. They have proven our profession wrong before; they will again.

The MMR "triple" vaccine for children, which has been controversially linked to autism and bowel disease, was introduced without adequate trials according to new research, published today.

Dr Andrew Wakefield, who caused a storm when he first questioned the jab in 1998, concludes that even 20 years ago there were warning signs that combining three live viruses in one vaccine could be dangerous. There was not "adequate evidence of safety" for the measles, mumps and rubella vaccine, which is now boycotted by many parents who are demanding three separate vaccinations for their children, one for each disease.

Dr Wakefield's conclusions have been hotly contested by ministers and the medical establishment. His latest research, published in the medical journal, Adverse Drug Reactions, comes as the Government is struggling to encourage parents to take up the MMR vaccine amid fears of a possible measles epidemic if figures do not improve.

Immunisation needs to be at least 92 per cent to protect the whole population, but rates have fallen as low as 75 per cent in some parts of the country because of concerns about the consequences. Around 500 families are taking legal action, claiming their children have developed autism or inflammatory bowel disease.

Dr Wakefield, a consultant gastroenterologist at the Royal Free Hospital, London, said parents should be offered a choice of either the MMR, which is given in a combined jab at around 15 months with a booster at the age of three, or single vaccines until safety fears are allayed. The Government has so far refused to make single vaccines available.

His report concentrates on the trials before the vaccine was introduced, which happened in 1975 in the United States and 13 years later in Britain. Studies on several hundred children in America showed that significant numbers of youngsters developed stomach bugs throughout the trial, but researchers took no long-term data. A study in 1969 showed that combining live viruses could have an effect on the body's immune response.

He added: "I am a firm believer in the protection of children against serious infectious diseases and their consequences. This paper advocates vaccination against measles, but issues of vaccine safety are vitally important and must be of paramount concern."

Four other experts were asked by the medical journal to review Dr Wakefield's controversial paper. Two supported his criticisms, while the others did not dismiss them.

Dr Peter Fletcher, a former principal medical officer at the Department of Health, said the evidence on MMR was "thin" and that the granting of the licence had been "premature". He said a year-long trial on 15,000 patients should have been carried out before it was introduced in Britain, instead of the three-week study involving 10,000 children.

Jackie Fletcher, of the anti-MMR pressure group JABS, said the report showed a huge question mark remained over the vaccine's safety. "We want the MMR to be suspended and parents to have the right to choose single vaccines so that children can still be protected against the diseases."

But a British Medical Association spokesman dismissed the study. Dr Simon Fradd said: "There is no new evidence in this paper, other than a review of previously published papers relating to the triple vaccine. MMR is a safe and effective vaccine and we strongly recommend that children are protected with it."

A Finnish study of 1.8 million children published earlier this month found no cases of autism or bowel disease linked with the vaccine. Nearly half of 173 adverse reactions were probably caused by something else, the study concluded.

A spokesman for the Department of Health said: "we are not aware of any country in the world that recommends that MMR be given as three separate vaccines. In Japan, where they do not have a suitable MMR vaccine licensed for use, there have been 79 measles deaths between 1992 and 1997. In the same period in the UK there were no deaths from measles. Dr Wakefield does not produce any new data and his review of published articles is highly selective."

21 Jan 01 - Medicine - The case for MMR

Dr Wakefield is on a crusade. In the past, he has asserted that the measles vaccine causes bowel disease and linked MMR to autism, and now that MMR was licensed without proper safety studies.

Before we look at his recent claims, we need to remember that he has been wrong before, and his views have no support from experts in vaccines. We also need to recognise that this is not a problem faced by the UK alone. MMR is used all over the world, and it is likely that the US, Canada, Australia and other countries made their decisions on the same data. So were they all wrong, or is Dr Wakefield wrong? The evidence points to MMR having an excellent safety and efficacy record in use, with hundreds of millions of doses used.

In his new paper, Dr Wakefield appears not to know the facts, and fails to report all the evidence. He gives the wrong dates when vaccines were licensed, he misleads readers over just how long follow-up studies really took place, and he uses wrong statistical analyses.

He raises scares about MMR safety, such as possible problems from giving three viruses together. Here he uses the example of the rare but terrible brain-damaging condition SSPE that results from measles - possibly made worse if another infection occurs with it. But the evidence is clear: measles vaccine protects against SSPE, and US and UK data show the condition became even rarer after the switch to MMR. Parents should be reassured that even if this scare had a theoretical basis, in reality the evidence supports MMR.

When Dr Wakefield sent us his paper challenging MMR safety, we asked our two independent expert committees to review it. The Joint Committee on Vaccination and Immunisation concluded that "reports from Dr Wakefield's group did not give grounds for concern over the safety of the vaccine", and noted inconsistencies, the lack of rigorous logic and the failure of confirmation by a wide range of independent investigators. The committee concluded that the analyses carried out by Drs Wakefield and Montgomery were intrinsically flawed." The Committee on Safety of Medicine also looked at the paper, especially to check that the licensing had been sound. It concluded that the process was properly conducted and that the licensing followed normal procedure and was based on robust studies.

Dr Wakefield wants more research. Independent researchers have not replicated his studies on vaccines across the world. In Japan, measles and rubella vaccines are given separately. From 1992 to 1997, there were 79 deaths from measles. Here, there were none. Yet Dr Wakefield wants us to risk children's lives without a shred of evidence. Children's health is too important to became a victim to his crusade.

The government is planning a new campaign to bolster confidence in the MMR vaccine in the wake of claims that it may be linked to 170 cases of autism and bowel disease.

A summit conference of medical organisations called by the health department today is expected to rebut the latest claims by Dr Andrew Wakefield, the researcher at the Royal Free Hospital, London, whose warnings about the potential risks of MMR (measles, mumps and rubella) have alarmed thousands of parents.

The conference, to be attended by the four chief medical officers of England, Wales, Scotland and Northern Ireland, will address the growing crisis over the uptake of the MMR vaccine, which has fallen from 93 per cent of the child population to 88 per cent nationally, with rates dropping as low as 74 per cent in some areas.

Health officials warned last week that Britain faced the threat of a measles outbreak after 3,500 cases and five deaths were recorded in the last year in two outbreaks in the Dublin area of Ireland and in the Netherlands, where vaccination rates are similarly low.

Dr Wakefield, a specialist in gastroenterology (diseases of the gut), claims the number of children he has identified with bowel disease and autism following MMR vaccination had now reached 170, although he admits he has not yet proved the link was causal. Experts claim it is coincidence.

In a separate scientific paper published in the Journal of Adverse Drug Reactions yesterday, he claimed safety tests on MMR before it was introduced in the UK were inadequate. The department of health rejected this, saying the paper contained no new data and was "highly selective".

Dr Wakefield, backed by a small group of like-minded researchers, has become increasingly isolated in the face of a medical and scientific establishment which is near-united in its opposition to him. He said yesterday: "We have established a link between autism and bowel disease and the bowel disease is consistent with a viral pathology. Other scientific data suggest the measles virus has been identified in these children. The crucial question is whether it is a causal relationship and to establish that we have to go to another level. But given the parents' stories that their children regressed following the MMR vaccination we have to take those stories extremely seriously."

He added: "We have the means to artificially dissociate [the three vaccines] to prevent this potentially disastrous consequence. Please provide parents with the choice until this is resolved scientifically."

In response, the health department cited Japan, the only country in the world which recommends single vaccines and which has suffered recurrent measles outbreaks. There have been 79 deaths from measles between 1992 and 1997 in Japan compared with none in the UK over the same period. It also cited a Finnish study published in December of 1.8 million children given MMR since 1992 which found no link with autism or bowel disease.

A spokeswoman for the department of health said: "It is not a simple issue of parental choice, because the choice parents make affects other members of the community."

Dr Wakefield, who is married with children, has been a thorn in the side of the public health establishment since returning to the UK in 1990 from Canada where he was a transplant surgeon, operating on diseased bowels. While in Canada he became obsessed with the causes of bowel disease and once back at the Royal Free became convinced that the measles virus could be responsible. He has published a number of scientific papers in international medical journals in the last decade but has failed to persuade the scientific community that his theory is right.

He protested yesterday that the department of health's claims that the MMR vaccine was safe were "untenable". Experts pointed out that it is impossible to prove a medical procedure is safe - that there will never be any adverse events linked to it - but it is always possible to raise doubts by citing individual cases of damage that might be linked to it.

The Government will be seeking backing from the 10 medical organisations attending today's meeting - including the British Medical Association, Royal College of Paediatrics and Royal College of Nursing - for a five-point campaign to rebuild professional and public confidence in the MMR vaccine. The campaign is expected to include television and press advertising, a letter from the Chief Medical Officer to all GPs and health professionals, roadshows for the public and an information pack containing all the relevant research.

A spokeswoman said: "This is about winning hearts and minds to support the vaccine programme and counter scaremongering." Dr Simon Fradd, deputy chairman of the BMA's GPs committee, said: "Dr Wakefield has not demonstrated that separating the MMR vaccine into three single vaccines would lessen the risk.

"We are worried that he is pushing for publicity. By all means push for money for research but it does not benefit the public if you cause alarm about a vaccine that leads to more disease."

21 Jan 01 - Medicine - Blood test may help to detect schizophrenia

Pinpricks of blood could soon reveal if a person is suffering from schizophrenia, the most debilitating of all mental illnesses.

Scientists have revealed they can detect differences in levels of the brain chemical dopamine - closely linked to schizophrenia - in individuals' blood streams. The researchers claim the test is sufficiently accurate to pinpoint whether that blood came from a schizophrenic or a healthy individual.

'We were able to differentiate between blood taken from 14 schizophrenics and a group of 10 people who were unaffected by the disease,' said Professor Sara Fuchs, of the Weizmann Institute in Israel. 'However, we have to make sure this is a reliable indicator of the disease before we can go any further, and have now launched trials on a much bigger sample.'

At present, diagnoses of schizophrenia are based on observations of patients' behaviour. Typically, they feel their lives are being controlled, and their thoughts directed by others. They hear voices and can form delusions about the world around them.

Just 1 per cent of the population suffer from the condition, which is known to involve the activity of dopamine, a chemical involved in communications between nerve cells. Dopamine locks on to receptor molecules on brain cells and directs their behaviour. The more dopamine receptor cells that a person has, the more likely that person is to have developed schizophrenia, researchers have found.

'However, it is virtually impossible to count the dopamine receptors in a person's head,' added immunologist Fuchs, whose team's study is published in the current Proceedings of the National Academy of Sciences. 'The only way would be to remove their brain cells, and count their receptors - which is not really practical.'

However, the discovery that dopamine receptors are also found on the surfaces of white cells, which circulate in our bloodstream and help protect the body from invading bacteria and other microbes, has opened up new prospects for medical researchers.

'Isolating white blood cells is a lot easier than sampling brain cells of living people,' said Fuchs. 'But counting dopamine receptors is still tricky.' So the Weizmann team analysed the genetic material that controls the making of receptors instead - and found a significant difference in one particular type, known as D3 receptors.

It was found schizophrenics had, on average, more than three times the amounts of dopamine of healthy individuals, with levels varying from between 2.4 to 7.1.

Pinpointing mental status from blood could be a powerful tool in dealing with psychiatric illnesses. But Fuchs warned the technique would have to be rigorously tested before being brought into widespread use. In particular, there could be a danger if tests gave too many false positives, labelling individuals as schizophrenic when they were actually unaffected by mental illness.

'It's unlikely to be used to screen populations to uncover potential schizophrenics,' added Fuchs. 'It is unlikely to be accurate enough. However, it can take psychiatrists months to use behavioural criteria to diagnose the disease. This test could cut that dramatically.'

18 Jan 01 - Medicine - Milburn admits superbug is endemic

Mr Milburn blamed years of neglect for the poor state of hospital sanitation which meant that one in three failed basic checks in the autumn. He said that a second round of unannounced checks was under way as part of "the biggest ever NHS clean-up" over the next two months. Of 50 failing hospitals re-inspected, 41 had moved from "red" for poor to "amber" for acceptable.

Cases of MRSA (methicillin-resistant Staphylococcus aureus), which infects open wounds and can be fatal, have shot up in hospitals over the past decade. Just 67 cases were reported in 1990 compared with 3,110 in 1999.

Health experts blame the overuse of antibiotics, which has led to resistant strains of bacteria emerging, as well as sloppy hygiene standards in hand-washing, ward cleaning and instrument sterilisation. Mr Milburn, announcing extra money for cleaning and greater powers for ward sisters to direct hygiene priorities, at Homerton Hospital, Hackney, East London, yesterday, said that basic sanitation had "slipped off the agenda for too long".

Ward sisters will be given the authority to ensure that payments are withheld from contract cleaning companies if standards are not acceptable. He added: "They will have the clout that matrons had, to get the fundamentals right for patients."

The results of hospital re- inspections would be published when they were completed at the end of March, he said. Speaking to The Times, he admitted that MRSA posed a serious problem in hospitals.

Mr Milburn said that the £200 million surgical instrument sterilisation programme announced by the Government this month would help to combat the condition. He added: "We have got a big programme of decontamination and I have no doubt there is a proportion of MRSA we can eliminate. But, as clinicians will tell you, you cannot be in a position where you can get rid of it altogether. It is endemic but I am sure there is much that can be done."

The Public Health Laboratory Service said that MRSA had become more common in the past decade for a number of reasons. More patients are being saved by modern surgical techniques who would otherwise have died, but they are also more vulnerable to infection. Combined with that, hospital germs were becoming increasingly resistant to antibiotics.

A spokesman added: "To prevent organisms like MRSA you need good infection control and good hygiene. There is nothing new about handwashing but it is so vital that we need to keep reminding people about its importance."

The Staphylococcus aureus bacterium is carried on the skin or in the nose by around 30 per cent of the population. Patients whose wounds were infected were easily treated with penicillin 50 years ago. However, tests in 1998 showed that 32 per cent of Staphylococcus aureus infections recorded in hospitals were resistant to both penicillin and the antibiotic methicillin.

Other figures for that year show that England is not alone in experiencing an MRSA crisis. In the USA the MRSA figure was 28 per cent, in Belgium 40 per cent and in Japan 70 per cent.

However, in Scandinavia and The Netherlands, where fighting MRSA was made a priority, less than 1 per cent of Staphylococcus aureus infections were resistant.

17 Jan 01 - Medicine - Research paves way for repair of brain and spinal damage

Scientists may have found a way to stimulate the regrowth of damaged nerves that could lead to successful treatments for brain damage and spinal cord injuries.

Research results announced today have opened an avenue of study for scientists in search of ways to mend damaged brain cells and restore movement to paralysed limbs.

A team of neurobiologists have identified a procedure for blocking an inhibitor in the body that prevents the regrowth of nerves in the central nervous system - the brain and spinal cord. By blocking the inhibitor, the scientists hope to stimulate the regrowth of defective cells and so re-establish the nerve connections that will restore lost functions.

Stephen Strittmatter, professor of neurobiology at Yale University School of Medicine in New Haven, Connecticut, said that the research, published in the journal Nature, could open the door to new opportunities for treating paralysis , multiple sclerosis , stroke and brain injuries .

There are thought to be a number of inhibitors in the brain and spinal cord that prevent the growth of axons, the long filament-like strands that stretch out from a nerve cell to make connections with other cells in the central nervous system. Professor Strittmatter and his colleagues identified one of these inhibitors last year, a protein called Nogo, which appears to play an overriding role in preventing axons from regrowing after being destroyed. The latest research takes this work a stage further by isolating the protein on the surface of the nerve cell's membrane that acts like a door lock into which the Nogo "key" has to be inserted to trigger its inhibitory effect.

"We found the key last year and now we've discovered the lock that it fits into. The effect of the key when it is in the lock is to close the door on the regrowth of axons," Professor Strittmatter said.

"The general idea is that we would be able to develop a molecule or drug that would bind to the Nogo receptor lock and so prevent the key from working," he said.

The axons of the nerve cells outside the central nervous system - for instance in the arms and legs - are known to be able to regrow after being damaged.

17 Jan 01 - Medicine - NHS to stop keyhole surgery for hernias

Hernia operations, the most common surgical procedures in the health service, should be performed using conventional open surgery rather than the newer keyhole techniques, a government agency has concluded.

The decision by the National Institute for Clinical Excellence (Nice), set up to monitor new drugs and treatments, is a blow to proponents of keyhole techniques, which have been promoted as the future of surgery. Nice says they should be avoided in patients with first-time hernias.

Keyhole surgery involves a smaller incision than conventional open surgery, causes less pain and scarring and is quicker to heal. The surgical instruments are inserted through a small hole in the abdomen and manipulated with the aid of a miniature camera.

But in inexpert hands there is a risk of damage to internal organs and keyhole surgery is more expensive - £747 per operation on average compared with £412 for the conventional kind.

An estimated 105,000 people develop an inguinal hernia, a bulge in the groin caused by a weakness in the abdominal wall, every year in England and Wales.

The condition is much more common in men - who account for 98 out of 100 cases - and three out of 10 people who get a hernia on one side will develop a second on the other.

In guidance for the health service published yesterday, Nice says that for hernias that recur or affect both sides, keyhole surgery should be considered, but it recommends that a new technique, the totally extraperitoneal procedure, is to be preferred.

This technique avoids penetrating the abdominal cavity, and reduces the risk of damage to internal organs, but it is more difficult.

The agency's report says that keyhole surgery "should only be undertaken in surgical units with appropriately trained operating teams".

17 Jan 01 - Medicine - A Question of Health: Is aspirin the only help for mini-strokes?

Q. I have had a number of mini-strokes, but fortunately none has left me with any permanent disability. I have been advised to take a daily dose of aspirin to thin the blood, but I am finding that aspirin upsets my stomach. What else can I do to prevent further strokes?

A. You have had transient ischaemic attacks or TIAs. These are similar to strokes, but the difference is that strokes cause permanent damage to the brain, while TIAs resolve within 24 hours, leaving no damage or disability. Aspirin, even in small doses, will reduce the chance of further TIAs. Try taking 75mg after food. If your stomach can't tolerate that, use a form of aspirin known as enteric-coated. This has an outer coat that sometimes makes it less irritant. If that fails, discuss with your doctor a drug called dipyridamole, which has similar effects to aspirin without the stomach side effects. Smoking is another important risk factor for strokes and TIAs, so if you are a smoker it is essential that you stop completely.

Q. I am developing a pinkish growth on the surface of my eye and although it is not painful, I am worried that it will soon begin to interfere with my vision. Could this be the beginning of a cataract?

A. Cataracts develop within the eye, not on the surface, and they are not visible when you look in the mirror. If this growth is on the surface of the white part of the eye it is probably a pterygium (the "p" is silent when it is pronounced). A pterygium is a benign growth that is more common in people who have lived in hot, sunny climates. Exposure to ultraviolet light is one of the factors that cause it to develop. A pterygium is usually wedge-shaped, and as it grows it slowly advances towards the pupil. It can be removed by a relatively simple operation, but if it is not causing any discomfort and is not interfering with your vision, there is no need to have it removed. There are other types of growth that can appear on the surface of the eye, and it is important to see a doctor who can make a definite diagnosis.

Q. I heard recently that grapefruit juice can influence the effectiveness of some drugs. Is this true? Which drugs are affected by grapefruit juice?

A.Bizarre as it may sound, it is true that grapefruit juice can interfere with the metabolism of quite a large number of drugs. The effect - called The Grapefruit Juice Effect - is usually to increase the amount of a drug that circulates in the bloodstream, sometimes by a substantial amount. There is a long list of drugs that have been reported to be affected by The Grapefruit Juice Effect. The most important ones are cyclosporin (used to stop rejection of transplanted organs) and a widely used antibiotic called erythromycin. A commonly used antihistamine - Triludan - was withdrawn from the market last year because it caused heart irregularities that were made worse when it was taken with grapefruit juice. Some blood-pressure and angina drugs called calcium channel blockers (the names all end in "pine") are also influenced by grapefruit juice. If in doubt, read the patient information leaflet with the tablets and ask your doctor.

17 Jan 01 - Medicine - New drug 'illegally tested on children'

An inquiry is under way in Nigeria into allegations that the multinational pharmaceuticals company Pfizer used an experimental drug on sick children during a major outbreak of meningitis, without official approval.

Yesterday the Nigerian doctor employed by Pfizer to run the clinical trial in Kano said that the letter certifying approval by the ethics committee at the hospital where the children were treated was probably written a year after the experiment took place.

Pfizer admitted last night that there did "appear to be possible documentary irregularities" and said they were co-operating fully with the inquiry.

Pfizer sent a team in to Kano at very short notice in 1996, when it heard of the outbreak of spinal meningitis. The company wanted to test the efficacy of its new drug Trovan on children, and such outbreaks in the west are now relatively rare.

About 15,000 people died in the epidemic, and children from a wide area were brought to Kano because of its infectious diseases hospital, staffed by volunteer doctors from Médecins sans Frontières.

Pfizer set up a temporary clinic nearby and treated 200 children, half of whom were given the new drug, a pill, and half the "gold standard" drug, cephtriaxone, given by injection.

Five of the children given Trovan died, together with six who were on the standard treatment.

But the Washington Post, which has been investigating the drug trial, has alleged that at least one child was not taken off the experimental drug and given the tried and tested treatment when it was clear that her condition was not improving, flouting the ethical rules of clinical trials.

Yesterday further questions were asked about the ethics of the trial as the doctor working for Pfizer in Kano, Abdulhamid Isa Dutse, admitted to the Post that it was "possible" that the letter certifying that the trial was authorised was written as much as a year after Pfizer's team had left.

Doubts about the letter, which was taken as proof to the US food and drug administration that the trial had been ethically carried out, was intensified by statements from two other Nigerian doctors.

Sadiq S Wali, the hospital's medical director, told the Post that the document was "a lie". He said the hospital had no ethics committee at the time of Pfizer's trial It only organised one, and created the letterhead stationery that was used on the letter, months later.

Dr Idris Mohammed said he had challenged the correctness of the Pfizer project at the time.

"There was no ethical committee at the time of the trial, none met, and no approval was properly given for the trial," he said.

The latest revelations are hugely embarrassing to Pfizer, which insists there was a philanthropic element to the trial.

MSF was using the only drug that was available in Nigeria -one that had not been allowed in the west for 50 years because of the side effects- said Pfizer's spokeswoman, Kate Robins, whereas Pfizer introduced not only its experimental drug, for which it already had safety data from more than 5,000 patients, but also the "gold standard" drug used in the west, cephtriaxone.

"This was not in any way a cavalier effort," she said.

Asked why, in that case, Pfizer had treated only 200 children when the epidemic killed 15,000, she added: "This is the first time we'd done that in epidemic meningitis. Science governs our decisions."

The experimental drug used, Trovan, has since been licensed, but not for children. However, it is not marketed in Nigeria.

Like all new drugs, which have a 20-year patent protection, the cost is too high for developing countries.

16 Jan 01 - Medicine - Simple test may help to detect schizophrenia

The first simple blood test for schizophrenia has been developed in a breakthrough that could revolutionise diagnosis and treatment of the illness.

Scientists at the Weizmann Institute of Science in Israel have discovered a way of diagnosing schizophrenia by analysing white blood cells for signs of a chemical that is overactive in patients with the condition. As a result, doctors may soon be able to tell whether a patient is affected by taking a blood sample.

At present, schizophrenia, which affects as many as one in a hundred people, can be diagnosed only by psychiatric observation and assessment. The procedure makes it difficult for the illness to be diagnosed and treated early. It can also be unreliable, because psychiatrists must rule out other factors that could cause similar symptoms, such as epilepsy, brain injury, drugs or thyroid problems.

The new test, details of which are published today in the US journal Proceedings of the National Academy of Sciences, is based on the chemical dopamine, which works as a neurotransmitter in the brain, easing communication between nerve cells. The research may also contribute to efforts to develop drugs with which to treat the illness, the Israelis said.

Scientists have known for some time that dopamine is overactive in the brains of schizophrenic people, and post-mortem studies have indicated that this is because patients with the condition have a larger than normal number of dopamine receptors in their brain cells.

The number of dopamine receptors in brain cells is virtually impossible to measure with any precision in living patients so attempts to develop a diagnostic test based on the chemical have proved elusive. The Weizmann team has devised an ingenious alternative by which a patient's white blood cells, rather than brain cells, can be analysed for signs of D3-receptors. The receptors are difficult to identify so the researchers, led by Sara Fuchs, Professor of Immunology, looked instead for evidence of molecules of RNA genetic code that conveyed the instructions for making dopamine receptors.

Professor Fuchs discovered that the blood of patients with schizophrenia contained on average 3.6 times as many messenger RNA molecules as the blood of healthy people. The findings were unaffected by any drugs the patients were taking to control their symptoms, suggesting that the test looks for the underlying causes of the disease rather than for symptoms.

The test has not been submitted for regulatory approval for clinical use and the Weizmann team need to perform further studies to perfect it. Nevertheless, the researchers believe that it has the potential to revolutionise diagnosis, and even treatment.

"Our findings strongly suggest that D3-receptor RNA levels in peripheral blood lymphocytes (white blood cells) may function as convenient and reliable markers for schizophrenia, and thus assist in early diagnosis, which is frequently unclear, and possible follow-up of the illness," Professor Fuchs said.

Paul Farmer, a spokesman for the National Schizophrenia Fellowship, welcomed the development, although he said that it would not help those who already have the illness diagnosed. "It can take years for this kind of research to find a viable application in the real world," he added.

Scientists have created an immune cell that can seek and destroy leukaemia cells, and could be used to treat thousands of sufferers of the killer disease.

Researchers at Hammersmith Hospital and Imperial College School of Medicine in London have spent six years investigating the disease. The work, funded by the Leukaemia Research Fund, identified a single gene (WT-1) which is over-expressed in cells that cause leukaemia. The WT-1 gene "labels" the cells responsible for the disease and allows researchers to identify them.

The discovery, detailed in the journal Hammersmith Research, led Dr Hans Stauss to develop immune cells that can recognise a WT-1 label on cancer cells and destroy them. Results have shown the engineered immune cells will specifically destroy leukaemia cells and ignore normal cells of the same type.

The project is joining forces with the department of haematology at Hammersmith Hospital, led by Professor John Goldman, and clinical trials among leukaemia patients will be performed within the next two years.

Dr Stauss, reader in tumour immunology at Imperial College, said: "The principle we have developed can be applied to almost all forms of leukaemia and could signal a huge step forward in how we treat the disease. What makes this work even more exciting is that our findings can also be applied to solid cancers, such as breast or lung cancer, where there is similar over-expression of WT-1. The possibilities for new treatments are enormous."

The Leukaemia Research Fund has contributed £750,000 to the work so far and will fund the clinical trial at a cost of £104,000. Dr David Grant, the fund's scientific director, said: "This could well be the chink in the armour cancer doctors have been looking for. We look forward to the results of this trial and introducing a whole new range of therapies."

15 Jan 01 - Medicine - Pressure on NHS to offer pill for obesity

A drug to combat obesity is to be launched in Britain later this year, increasing pressure on the health service to treat fatness as an epidemic.

The drug, Sibutramine, is available in Germany and the US under the brand names Reductil and Meridia. A three-month course costs £40 in Germany.

Manufactured by BASF Pharma, the drugs wing of the German BASF conglomerate, it acts on the brain to stifle appetite.

Most of the world's big pharmaceutical firms are working on medicines to treat obesity, and there are fears that promotion of a stream of pills will distract from the reality that only lifestyle changes can reduce weight effectively.

"The public wants every new drug that comes along to be a magic bullet," said Philip James, a professor who chairs the International Obesity Taskforce, a charity. "That's one of the unfortunate cultural features of our age, and I think unscrupulous pharmaceutical companies will make use of it."

Some 61% of British men and 52% of women are thought to be overweight. Some 16% and 18% respectively are clinically obese, which can lead to diabetes and heart disease. A survey this month showed that in 10 years there had been a sharp increase in overweight children.

Sibutramine is expected to be given a Europe-wide licence this year by the European Agency for Evaluation of Medicinal Products, or EMEA, based in London. In February, the national institute for clinical excellence, which rules on NHS treatments, will announce whether another anti-obesity drug, Orlistat, should be available; it was to make a recommendation for Sibutramine at the same time, but is awaiting the Emea decision.

Sibutramine was invented in Nottingham in the early 1990s by scientists working for Boots, whose laboratories were sold to BASF in 1995. The drug was not designed to fight obesity.

"It was meant to be an anti-depressant, because they work in the same way, by increasing levels of brain chemicals like seratonin and dopamine," said a BASF spokeswoman, Christina von Landenberg. "When tested on 1,200 depressed people, they didn't become less depressed, but their weight decreased by several kilogrammes. So the company decided to develop it as an anti-obesity drug."

By itself, the drug will not help lose more than a few kilos, and the manufacturers say it should only be prescribed as part of a diet and exercise regime.

A BASF spokesman, Gunther Storz, said the firm's drugs wing had been sold to a US company and would be demerged within a few weeks.

BASF Pharma is one of the funders of a Washington lobby, the American Obesity Association, pressuring the US authorities to make obesity treatment tax deductible and to fund treatment for the elderly. BASF Pharma also contributes to the International Obesity Taskforce. Prof James said the money was "an unfettered educational grant" and the charity did not promote specific drugs.

Mr Storz said he saw nothing unethical about the marketing of drugs like Sibutramine. "I've discussed this with doctors from Germany and Switzerland, where the drug is licensed. They told me that, in normal circumstances, they only get 3% of obese patients to change their lifestyle; the rest just aren't able to alter their habits. With Reductil, they succeed with 30 to 50%."

Peter Kopelman, a professor at St Bartholomew's hospital in London, said: "These drugs should not be regarded as a simple answer... but we do have a medical problem called obesity.

"I have a clinic. The average age of my patients is 35. They are very large people. Many can't get in to the clinic because they're so breathless. Some, in their 30s, have heart and respiratory failure. Many have diabetes.

"Yes, if they could have changed their lives earlier, they wouldn't have reached such a dire state, but given that they have, I need to have some kind of medical treatment to offer."

15 Jan 01 - Medicine - New jab hope for victims of leukaemia

The groundbreaking discovery of an immune cell that can seek and destroy leukaemia cells could lead to a new treatment for thousands of sufferers of the killer disease, it is revealed today.

The cancer of the blood claims more than 5,000 victims a year. Scientists will take white blood cells from a healthy volunteer, engineer them to recognise leukaemia cells and then inject them into patients. In theory, the invading T-cells will act as a healthy immune system and eliminate the cancerous cells.

Lord Robert Winston, director of research at Hammersmith Hospitals NHS Trust, said: "To the best of our knowledge, this is the first time in the world that anyone has identified a target which allows T-cells to selectively destroy cells that cause leukaemia.

"Such a breakthrough underlines the vital importance of long-term academic research in the production of desperately needed treatments."

Hans Stauss of Imperial College school of medicine worked with Hammersmith teams on the new approach. He identified a gene called WT-1 that becomes overactive in cells that cause leukaemia. This meant that the cells were, in effect, labelled and easily recognised.

The next step was to take immune cells and engineer them to destroy leukaemia cells but not ordinary ones of the same type. Drugs normally taken for leukaemia suppress the immune system, so the patient would not reject the imported T-cells. In effect, a patient would "borrow" an immune system off the hospital shelf to mop up the cancer.

So far all tests have been in the laboratory. But with backing from the Leukaemia Research Fund charity, he and colleagues are preparing for the first trials on patients.

"The principle we have developed can be applied to almost all forms of leukaemia and could signal a huge step forward in how we treat the disease," said Dr Stauss. "What makes this work even more exciting is that our findings can be applied to solid cancers where there is similar over-expression of WT-1. The possibilities for new treatments are enormous."

Various cancers of the blood affect 18,000 people in Britain every year. Drugs can be effective, but they also kill healthy cells and have side effects that make the patient feel wretched. Bone marrow transplants involve radiotherapy and long stays in hospital.

"It's fatal attraction of the most specific kind," said David Grant, scientific director of the LRF. "Once the introduction is made between cancer cell and killer T-cell, the immune system goes in for the kill.

"The beauty of this technique is that it does not require using cells from the patient. The killer T-cells, directed to particular targets, will be available off the shelf."

At first the treatment will be used after conventional drug therapy. But it could ultimately provide much more powerful treatments that would lessen the need for toxic drugs.

"This could well be the chink in the armour cancer doctors have been looking for," said Dr Grant.

15 Jan 01 - Medicine - Scientists in leukaemia advance

by Zoe Morris and Indira Das-Gupta

Evening Standard - Monday 15 January 2001

A major breakthrough in the treatment of leukaemia and a possible vaccine for cervical cancer were unveiled by scientists today.

London researchers have discovered a "hunter-killer" immune cell which could provide a cure for leukaemia within the next five years.

The ground-breaking discovery was made by a team at Hammersmith Hospital and Imperial School of Medicine who have spent six years investigating the killer disease.

A single gene - WT-1 - has been identified which is "over expressed" in cells that cause leukaemia. This means the gene can be used as a "label" to identify the harmful cells.

Dr Hans Stauss has used this principle to develop immune cells which can destroy the WT-1 labelled cells.

So far, trials have shown that these engineered immune cells will attack and destroy the potential leukaemia cells, but will ignore healthy cells.

Dr Stauss said: "The principle we have developed can be applied to almost all forms of leukaemia and could signal a huge step forward in how we treat the disease.

"What makes this work even more exciting is that our findings can also be applied to solid cancers, such as breast or lung cancer, where there is similar over-expression of WT-1. The possibilities for new treatments are enormous."

Around 18,000 people are diagnosed with leukaemia or a related cancer of the bone marrow and blood every year.

Britain's first trial of a vaccine which could prevent cervical cancer was also launched today.

Two women have joined the Manchester-based trial which will eventually recruit 24 volunteers. It aims to boost women's immune systems against the human papilloma virus (HPV) which causes almost all cases of cervical cancer.

Studies show that up to 50 per cent of women may be infected with HPV during their lifetime. In most cases, the virus, which does not cause any obvious symptoms, appears to disappear after a few months.

Professor Julian Peto, of the Cancer Research Campaign, said: "In the long term, the best way of preventing cervical cancer has to be by wiping out the HPV infection that causes it."

13 Jan 01 - Medicine - Ministry is blocking single-dose vaccines

Single dose vaccines for measles, mumps or rubella will not be made available to British children, health officials said yesterday as they began a new drive to reassure parents of the safety of the all-in-one vaccine.

Despite growing calls for single vaccines to be made available to the minority of parents who refuse to let their children have the triple jab, they said the single dose alternative was more dangerous. Dr David Salisbury, head of immunisation at the Department of Health, said: "We cannot support a policy that would put children at risk. Separate injections are less safe."

Three years ago, researchers suggested a link between the MMR vaccine, introduced in 1988 and autism and inflammatory bowel disease in children. This link has not been supported by other research. However, 500 parents are planning to sue the Department of Health over damage to their children allegedly caused by the vaccine.

Vaccination levels have fallen from 92-93 per cent to an average 88 per cent and it is as low as 75 per cent in some parts of the South East. The Department of Health has already issued a warning of a measles outbreak as children who have not been protected return to school. Julie Kirkbride, Conservative MP for Bromsgrove, is introducing a Private Member's Bill calling for single doses to be available.

Yesterday, Dr Liam Fox, the shadow health secretary, added his weight to the proposal. He said that the Conservatives would reintroduce single-dose vaccines if they were re-elected - if vaccination levels were still low. He said: "It must be better for children to have a single vaccine than to have nothing at all. This is not an ideal situation but it must be infinitely preferable to the prospect of dead or damaged children."

He said: "There is no point sitting on the high moral ground awaiting an epidemic that could claim the lives of children in Britain. It's a huge failure of the Government's health policy - neither to reassure the public effectively nor to provide an alternative. We cannot sit by and watch immunisation rates fall to levels that will virtually guarantee a measles epidemic."

Ministers were understood to be "furious" over Dr Fox's "purely opportunistic" comments. A Department of Health source said: "It is all very well the Tories jumping on bandwagons when it is politics but it is deeply irresponsible when it is children's lives."

Yesterday the department again sought to allay fears about the safety of the vaccine. The chairmen of both independent bodies that advise the Government - the Committee on Safety of Medicines (CSM) and the Joint Committee on Vaccination and Immunisation - reiterated their belief, based on scientific evidence, that the vaccine was safe.

Professor Alasdair Breckenridge, CSM chairman said: "The evidence of long-term safety of MMR, especially in respect of autism and inflammatory bowel diseases, is very convincing." The Department of Health made available a report from the "largest ever" study of adverse events following MMR vaccination.

The 14-year study from Finland was published in America in the journal Paediatric Infectious Disease last December. It confirmed the results of an earlier analysis of 1.8 million vaccinated children published in the Lancet in 1998. The report said that serious side-effects related to MMR vaccine were rare "and greatly outweighed by the risks of natural MMR diseases".

The researchers found an adverse reaction rate of 3.2 per 100,000 doses of vaccine. But Marilyn Smith, of the parent support group Jabs, said: "When you've got a child it's the most precious thing in the world and no amount of figures can change the concerns we have about MMR."

Another study, published yesterday in the British Medical Journal, said that about half of health professionals had reservations about giving children a second dose of MMR vaccine before they started school.

13 Jan 01 - Medicine - MMR: 'No one can say it's safe

As Michelle Claude and Tami Everett rolled up the sleeves of their infant sons for their measles jab yesterday, they were coming to the end of a search that began more than a year ago. The friends from Bournemouth had made a pact at their mother-and-baby club: to find someone, somewhere, who was prepared to ignore orders from the Government and the medical profession and give their boys, Jacques and Freddie, an alternative to the MMR triple vaccine.

Yesterday, after driving three and a half hours from Bournemouth, they arrived at the Direct Health 2000 clinic in Eltham, south-east London, to join a rapidly growing queue of parents who now refuse to accept ministerial advice and trust the MMR vaccine.

"It's important isn't it? It's your children's health at the end of the day," said Ms Everett, 28, a former croupier. "No one can prove to us that the MMR is safe." The logic is simple. "If there was no problem, there would be no controversy."

For these parents, finding private clinics that will dispense the three single vaccines for measles, mumps and rubella has become a quest. After the BSE scandal, they are driven by mistrust of government advice and, thanks to media reporting, fear about the alleged link between autism and inflammatory bowel diseases and MMR.

For Sarah Dean, the Eltham clinic's managing director, the scare has become big business. Her clients, including some parents who travel from Glasgow and Swansea, will spend £105 for the three injections and take a day off work for each injection, which must be taken six weeks apart.

The clinic, which handles travel and flu vaccinations, has seen these orders quadruple to 20 a day in the past week. The injections are unlicensed in Britain, but she is now planning mobile clinics in Swansea, Sheffield and Bristol by legally importing doses from other European Union countries.

Yesterday, her customers included Liz and Darren Sherborne, who drove 120 miles from Gloucestershire, to get a single measles jab for their 14-month-old son, Benjamin. They had heard that 2,000 people were suing the MMR's vaccines makers. "It's a question of confidence, isn't it?" said Mr Sherborne.

But for many parents the root of this crisis is the failure of the Government and medical profession to explain and defend their insistence on MMR vaccinations. Paul and Debi Kelly, who had driven their twin daughters Amelia and Maddison across London from Barnet, were given no help by their GP. "He just said: 'You will have this done'," Mr Kelly said. "We just want to hear a decent argument against doubts that have been raised."

12 Jan 01 - Medicine - Health minister backs nurses with HIV

Gisela Stuart, the Health Minister, today backed a health authority that is allowing trainee African nurses with the HIV virus to come into contact with patients.

Wolverhampton Health Authority said between five and ten men and women with the virus were currently either working at hospitals in the city or completing a three-year nursing course.

Ms Stuart, who also represents the Birmingham Edgbaston constituency, said: "Just because someone carries the HIV virus doesn't mean they develop full blown Aids. There has been screening. That's why they are picking this up.

"There are very careful procedures that they are not working in high-risk areas. There have not been any cases where a patient has been infected by a health care worker."

Health chiefs detected the condition through checks carried out on the nurses' arrival in Britain from the sub-Sahara region of Africa to take up places at the Wolverhampton School of Nursing and Midwifery.

None are working in "high-risk procedures" such as operations. To protect the nurses' confidentiality, patients will not be told which staff and students are HIV positive.

12 Jan 01 - Medicine - Biggest study clears MMR of harm

The world's largest study of the controversial measles, mumps and rubella vaccination (MMR) has categorically ruled out any link to autism and serious bowel disorders.

Health officials hope that the vast survey will reassure British parents who have been rejecting the jab in droves over health scares.

Three million doses of the combined vaccine were followed up by Finnish researchers who found they caused not a single case of autism or Crohn's disease.

Nine million British children have had the vaccine since its introduction here in 1988, but the Public Health Laboratory Service said last week that immunisation levels had fallen to 75 per cent in some areas.

It is likely to seize on the findings of a study by Helsinki University Central Hospital which tracked the side-effects of MMR from 1982, when it was introduced in Finland. The researchers concluded: "No case of inflammatory bowel disease or autism was detected during this long follow-up study.

"This finding is important because were there an association with MMR vaccination after such a short interval as suggested, this prospective study design would undoubtedly have disclosed at least some cases."

Every hospital and health centre in Finland was asked to report any adverse effects of the MMR vaccination between 1982 and 1996 when 1.8 million children were inoculated. The study was funded by Merck, which makes MMR, and reported in the US journal The Pediatric Infectious Diseases Journal.

It found that, as with all vaccinations, there were some side-effects. These amounted to 78 serious incidents or 3.2 per 100,000 doses. Most were either allergic reactions such as shock (49 cases) or fits (28 cases). The researchers concluded that the risks were minuscule compared with the benefits of avoiding mumps, measles or rubella.

The Health Department welcomed the findings, especially in the light of today's British Medical Journal which reports that one in eight GPs believes that MMR may be linked with autism.

The health scares over MMR began with research in the United States in 1998 that claimed that the combined vaccine could damage the brain. The pressure group Jabs believes that MMR has led to 1,800 children developing autism and other problems.

12 Jan 01 - Medicine - Many GPs fear triple vaccine link to autism

One in eight GPs and a quarter of their practice nurses believe that there is a link between the MMR vaccination and autism, a survey has found.

A higher number suspect that the triple vaccination against measles, mumps and rubella can trigger Crohn's disease, a bowel disorder which a number of parents believe developed in their children after they had the injection. The findings, published today in the British Medical Journal, will concern health officials trying to convince the public that the inoculation is safe. Children have their first dose between 12 and 15 months and a booster when they start school.

Fears over safety have led to a sharp drop in uptake.

The Public Health Laboratory Service (PHLS) has said that 100,000 children are at risk of measles as the school term starts because they had not had even the first dose. The parents' group Justice Awareness and Basic Support campaigns for three separate vaccinations and believes that the combined version has led to 1,800 children developing problems such as autism.

The opinions of doctors and nurses in the North Wales Health Authority were surveyed: 7 per cent of health visitors thought that it was "very likely or possibly" associated with autism, compared with 13 per cent of GPs and 27 per cent of practice nurses. Eleven per cent of health visitors thought there could be a link with Crohn's disease, as did 13 per cent of doctors and 33 per cent of nurses.

The researchers, who included Mary Ramsay, a PHLS consultant, noted that the survey was done in 1998, soon after media coverage of American research linking MMR to brain and bowel disorders. She said: "This survey shows how much confusion there is, even among health workers. There is no link between the MMR and autism and Crohn's disease - all the proper studies have shown that. This vaccine was used safely in the US and Scandinavia for 16 years before we introduced it.

There are side-effects, as with all vaccinations. It can cause temperatures and occasionally fits but it does not kill children or cause brain damage in the way measles does."

Opinions on giving a second dose to children aged three to five, said by officials to be vital because one in ten do not gain immunity from the first dose, were also surveyed. Fifty-four per cent of GPs totally agreed that the second dose was necessary; 40 per cent agreed with reservations; and 3 per cent disagreed. Just 41 per cent of health visitors and practice nurses agreed completely, with 10 per cent of health visitors and 2 per cent of practice nurses disagreeing. One nurse told the researchers that giving two injections to a young child distressed the child, the parent and herself.

Ten of the 460 health professionals did not give their children the second dose. One said: "I personally will not let my children have their second MMR but I don't influence parents. I let them read the factsheet and decide."

12 Jan 01 - Medicine - The MMR controversy

- The combined measles, mumps and rubella (MMR) vaccination was introduced in Britain in 1988.

- MMR is a live vaccine containing measles, mumps and rubella viruses that have been modified so they do not cause symptoms.

- The vaccine produces an immune response sufficient to protect children from the disease.

- Their system produces antibodies that kill the viruses in the vaccine. Lymphocyte cells then remember the response and react rapidly if the viruses recur.

- Children are given two doses of MMR, one at 12-15 months, the other at 3-5 years old.

- They need two doses because up to 10 per cent will not develop immunity to measles or mumps from just one injection.

- The MMR was in use in the USA and Scandinavia for up to 16 years before its introduction in Britain.

- As with all vaccines, there can be side-effects. One in 1,000 children have convulsions, 1 in 24,000 blood clotting, 1 in 100,000 a severe allergic response. No deaths are officially linked to the vaccine.

- Fears grew about the triple vaccine after an American study by Professor Vijendra Singh which suggested that the measles component in MMR could hamper the development of the myelin sheath surrounding nerves in the brain. If the sheath does not develop properly, nerve fibres fail to function correctly.

- Campaigners against the triple vaccine say it has led 1,800 children in Britain to develop autism, Crohn's disease (a bowel disorder) or other conditions.

- They believe that giving three separate vaccines is safer but there has been no national rise in cases of Crohn's disease since MMR was introduced, according to the Public Health Laboratory Service.

- A study of 500 autistic children by the PHLS last year found no link to the MMR vaccination.

- More than nine million children in Britain have been given MMR.

- An estimated one to two million children worldwide die each year from measles.

The scare about the controversial triple vaccine against measles, mumps and rubella (MMR) may have spread to health professionals. A study has found 48 per cent of family doctors , practice nurses and health visitors have reservations about giving the second dose of the vaccine to children.

The news came as the largest study of the vaccination ever undertaken reportedly ruled out any link to other conditions in children.

Finnish researchers followed up three million doses of the vaccination against measles, mumps and rubella and found no link to cases of autism and serious bowel disorders.

The Finnish research will be welcomed by campaigners concerned about falling immunisation levels in the UK and the risk of a measles outbreak, and will also bolster claims by health officials in the UK that the single doses are unnecessary and costly.

MMR, is normally given to children in two doses, with the first at 13 to 15 months and the second between the ages of three and five years. The vaccine was introduced in 1988 but the second dose was added to the immunisation programme in October 1996 as part of a World Health Organisation drive to eliminate indigenous measles from Europe by 2007.

The first dose of MMR gives a high level of immunity but a second dose is necessary to eliminate measles from the population. Researchers from North Wales health authority, where the study was done, say the findings are worrying because they threaten the WHO target.

The survey of almost 600 health professionals in Wales was conducted in May and June 1998, shortly after publication of controversial research at the Royal Free Hospital in London linking the measles virus with bowel disease and autism. The research, which has been widely criticised, led to a sharp fall in uptake of the MMR vaccine.

The Public Health Laboratory Service warned recently that there was a risk of measles outbreaks in some areas where immunisation rates had fallen as low as 74 per cent.

The Welsh survey, published in the British Medical Journal, found 94 per cent of the 157 GPs who answered the questionnaire agreed with giving a second dose of MMR but 40 per cent had reservations. Among practice nurses, 95 per cent agreed but 54 per cent had reservations; among health visitors 90 per cent agreed, 41 per cent with reservations.

Faced with a parent who was unsure about the second dose, 72 per cent of GPs, but only 42 per cent of practice nurses and 20 per cent of health visitors, said they would recommend the vaccination. On the claimed link with autism, 27 per cent of nurses said it was possible or very likely, as did 13 per cent of GPs and 7 per cent of health visitors.

Similar percentages considered an association with bowel disease was possible.

10 Jan 01 - Medicine - Doomsday virus is developed by accident

Scientists have accidentally developed a doomsday virus that kills its victims by wiping out part of their immune systems.

The virus only affects mice, but the team behind it are concerned that the technology could be adapted and used for biological warfare.

It was created by an Australian research team which was working on a pest control contraceptive for mice.

They were trying to get the mice to produce antibodies which would fight their own eggs and make the animals infertile.

During their experiments they genetically engineered a mousepox virus more powerful than its original version, reports New Scientist.

Ron Jackson, of Australia's scientific research experts CSIRO, said: "It would be safe to assume that if some idiot did put (a human version of this) into human smallpox they'd increase the lethality quite dramatically."

10 Jan 01 - Medicine - Parents flock to MMR jab alternative

by Zoe Morris, Health Reporter

Evening Standard - Wednesday 10 January 2001

A London clinic which is offering separate doses of the controversial measles, mumps and rubella vaccines has been inundated with inquiries from parents following renewed safety fears over the combined MMR jab.

Parents are travelling from all over the country to Direct Health 2000 in Eltham to get their children immunised using single doses of the vaccines which are not available on the NHS.

Concerns have been raised over possible links between the NHS's MMR vaccine and the onset of serious illnesses, including autism, stomach disorders and epilepsy. New research by Dr Andrew Wakefield at the Royal Free hospital, due to be published in the next two weeks, questions whether sufficient trials were carried out before the combined vaccine was introduced in the UK in 1988.

There is, as yet, no scientific proof that the MMR vaccine is harmful to some children, but around 2,000 families in the UK are taking legal action claiming their children went on to develop autism.

While questions remain about possible health risks campaigners are pushing the Department of Health to re-introduce the single vaccines which were phased out in 1998.

The private Direct Health 2000 clinic imports the vaccines - which are the same as those given to children in the UK before MMR was introduced - from Sweden.

After taking a detailed medical history, children are given the single jabs by a GP or nurse at six-week intervals. The measles and mumps jabs cost £35 each and rubella costs £25.

Sarah Dean, a practice nurse with 14 years' experience who set up the private clinic, now plans to travel to Bristol and Swansea to vaccinate hundreds of children. "We are getting between 75 and 100 inquiries a day from parents, grandparents and other relatives," she said.

The numbers of inquiries were boosted last week after warnings from the Government that the failure of many parents to agree to the MMR jab is leaving children vulnerable to an outbreak of measles.

Figures produced by the Public Health Laboratory Service confirmed that increasing numbers of parents, particularly in London, are opting to leave their children unprotected. In some parts of the capital the uptake of MMR has fallen to 74 per cent - sparking concerns of a re-emergence of the diseases, particularly measles. The Department of Health insists that the MMR vaccine is the safest and most effective way of protecting youngsters.

However, Mrs Dean said many parents were being "bullied" by GPs urging them to opt for MMR.

She said: "We had a mother in yesterday who had been told by her health visitor that if she went privately she would be charged for an injection of a sugar solution. We believe that, while there are question marks over the safety of MMR, parents should have the choice to opt for single vaccines."

Direct Health 2000 can be contacted on 020 8294 2780.

09 Jan 01 - Medicine - New drug will fight hospital superbug

A new drug to counter deadly hospital-acquired infections has been licensed for use in Britain.

Zyvox, which belongs to the first completely new class of antibiotics for more than 30 years, can treat infections that are resistant to almost all other drugs. These include "superstaph" - methicillin-resistant Staphylococcus aureus, or MRSA - which has grown rapidly in hospitals over the past decade and is now also being seen by GPs.

Nobody knows exactly how many cases occur in Britain each year, but estimates run as high as 100,000, with 5,000 deaths. Hospital-acquired infections cost the National Health Service £1 billion a year, according to an estimate by the National Audit Office.

Zyvox was developed by the US company Pharmacia, and was licensed in the US last year. Its approval by the Medicines Control Agency means that the UK arm of the company can now import supplies, which should be available within a week.

Mark Wilcox, consultant in medical microbiology at Leeds General Infirmary, has been involved with the trials. He said: "The choices for treating patients with MRSA have been very limited. Essentially there has been only one drug, vancomycin. That works very slowly, and not very effectively. Zyvox seems to work more quickly. Patients get better that bit quicker, and have to stay in hospital maybe a week less. That's important."

A second big advantage, he said, was that the drug could be given orally as well as intravenously. That meant that a patient could be released with pills to complete treatment at home.

According to Dilip Nathwani, a consultant at Tayside University Hospital in Dundee, releasing patients sooner would free beds and cut waiting lists, enabling trusts to meet government targets.

The drug will not be cheap. A spokeswoman for Pharmacia estimated that a typical ten-day course would cost £700. It will only be prescribed by hospital doctors, for conditions such as pneumonia, and skin and soft tissue infections, which are usually the result of infection after an operation.

MRSA has been rising steadily over the past decade. In 1990, only a few per cent of staphylococcal infections were MRSA, but by last year this had risen to more than 40 per cent. The bug has also begun to spread from hospitals. One study last year by the Public Health Laboratory Service in Peterborough showed that more than half the MRSA cases in the areas were being picked up by GPs.

Ultimately bacteria will develop resistance to Zyvox, as they have to other antibiotics, but Pharmacia hopes that will be many years hence. The new drug is a completely synthetic product, not a natural one that bacteria may have already met.

09 Jan 01 - Medicine - 800 haemophiliacs killed by HIV-infected blood

More than 800 haemophiliacs infected with HIV after being treated with contaminated blood products have died.

They are among the 1,240 sufferers who contracted the virus through NHS treatment before the link between HIV and the factor concentrates used to treat them was discovered in 1983.

It was not until 1985 that all of the products were heat treated to eliminate the risk.

Replying to a Commons written question from Jim Cousins (Lab Newcastle upon Tyne Central), Health Secretary John Denham said 99% of the 813 victims had been co-infected with hepatitis.

08 Jan 01 - Medicine - New fears over measles vaccine

by Zoe Morris

Evening Standard - Monday 8 January 2001

The London expert at the heart of controversial concerns over the safety of the measles, mumps and rubella vaccine has warned that the Government will face fresh calls to change its policy following the latest claims about insufficient trials of the jab.

Dr Andrew Wakefield, a consultant at the Royal Free Hospital, in Hampstead, is to publish new research expected to raise serious questions about whether the trials of the MMR vaccine were tough enough. It follows, speculation that the jab could lead to a range of serious health problems, including stomach disorders, epilepsy and autism.

Dr Wakefield said today he was unable to discuss details of the report, which will be published

08 Jan 01 - Medicine - Drug 'may help treat cancer'

By Malcolm Withers

Evening Standard - Monday 8 January 2001

Phytopharm's P54 treatment may be the answer to bowel cancer, the second most common cancer in males, it is claimed following tests conducted by the Leicester Royal Infirmary in collaboration with the University of Leicester and the Medical Research Council.

07 Jan 01 - Medicine - 'Itch-ometers' may hold key to eczema

Schoolchildren with eczema are being asked to wear "itch-ometers" at night in a research project to measure how much they scratch.

Professor Jonathan Rees, a dermatologist at Edinburgh University, is recruiting 50 young volunteers to wear miniature motion sensors on their wrists that will log when and how long they scratch. In addition, an infrared camera will be installed in each child's bedroom to record their patterns of wakefulness and disturbance. One child in 10 suffers from eczema - three times as many as 30 years ago - but doctors are still in the dark about how to quantify the severity of the disease and assess whether treatment is working.

Professor Rees said: "At the present we don't really have any measure. One person's skin can look dreadful but isn't very itchy, whereas someone else has hardly any marking but is itching terribly. It's like asthma. You can ask the family to tell you how things have been, but it would be much better to have a scientific measure like peak flows, to tell if the treatment is working."

Eczema causes enormous disruption for families, where it often goes hand in hand with asthma and hay fever. Steroid creams help to reduce the itching and inflammation, but the irritation still prevents the child, and therefore its parents, from getting a decent night's sleep.

Eczema sufferers are often bullied and ridiculed for their appearance. The condition peaks at about the age of four, then gradually fades, but half of all former eczema sufferers go on to develop hand dermatitis as adults which may limit their choice of career. Professor Rees, who himself suffered eczema as a child, hopes that the two-year trials will cast more light on the pattern of the condition and also help to suggest new treatments.

05 Jan 01 - Medicine - Sunshine vitamin 'is clue to MS'

Sunlight may protect against multiple sclerosis, heart disease and strokes, according to British scientists.

A study at the University of East Anglia of the incidence of MS in more than 30 countries has confirmed that people who live in sunny climates are at much lower risk of developing the disease than those from cooler parts of the world.

The sun's rays may also help to lower blood pressure, reducing the chances of having a heart attack or stroke, the team also found. Both beneficial effects of ultra violet-B (UVB) light are believed to stem from its role in producing the body's vitamin D.

The findings were presented yesterday at the Royal Geographical Society conference in Plymouth. Graham Bentham, Professor of Earth Sciences at East Anglia who led the study, said that the risk of skin cancer from over-exposure to UVB radiation is still higher and better supported by evidence than any protective effects it might have.

About one in 500 people in Scotland and Northern Ireland develop MS, about twice the incidence in England and Wales. Countries such as Norway and Japan, where the diet includes a lot of oily fish rich in vitamin D, have lower than expected rates of MS, suggesting that vitamin D was responsible for the benefits.

Scientists have developed a lotion that could prevent hair loss caused by chemotherapy.

The compound proved successful in tests on rats, suggesting that this approach may, one day, relieve cancer patients of a frequent and distressing side-effect of the treatment.

Although baldness caused by Looking better, feeling betteris temporary, loss of image is rated among the most difficult side-effects to cope with, after nausea and vomiting. No effective prevention method exists for this type of hair loss, called chemotherapy-induced alopecia, or CIA.

The side-effect occurs because many anti-cancer drugs work by killing cells that are rapidly dividing, one of the defining characteristics of cancer cells. However, normal cells in the hair follicle are also rapidly dividing cells.

The team at the company GlaxoSmithKline in North Carolina cut chemotherapy-induced alopecia by temporarily halting cell division in the hair follicles of rats. They did this by rubbing the animals' skin with a newly developed drug before chemotherapy.

The drug targets an enzyme called CDK2 that controls progression of cells through the cell cycle. Scientists are interested in blocking the enzyme either to protect normal cells, as in this case, or to kill cancer cells.

The GlaxoSmithKline team began by studying a previously discovered drug that weakly blocked CDK2. Armed with this information, they designed modified forms that bound more strongly to the enzyme and were shown to reversibly halt human hair follicle division. When the new compound was tried on rats which were subsequently given chemotherapy with two widely used anti-cancer drugs, hair loss at the site of application was reduced in 33 to 50 per cent of the animals.

The researchers were thrilled to see that the treatment did not interfere with chemotherapy and that hair was still growing on many treated animals. Dr Stephen Davis, one of the team, said: "There's nothing better than visual proof."

The substance used in the trials blocked cell division in the hair follicles at the point at which the enzyme CDK2 came into play.Dr Davis said: "What was more, it protected the cells from a panel of currently used chemotherapeutic agents".

GlaxoSmithKline said it was too early to speculate when the compound could be tested in the clinic. Nonetheless, the work shows that it is possible to arrest hair loss, and will spur other work in the field.

Dr David Fisher, of the Dana Faber Cancer Institute in Boston, said that it might be possible to design inhibitors to protect other tissue, such as the lining of the gut, so as to prevent nausea and vomiting.

05 Jan 01 - Medicine - Sun may protect against MS and strokes

Sunlight protects people against multiple sclerosis (MS) and prevents high blood pressure and strokes, according to research at the University of East Anglia.

Two related studies, covering 30 countries from the equator to the poles, show the beneficial effects of ultraviolet light in sunlight on both conditions.

Graham Bentham told the conference in Plymouth that it was already known that people in northern latitudes such as Britain were 100 times more likely than those on the equator to get MS but no one knew why. Within the UK there was a marked difference, with one in 100 getting MS in England and Wales and one in 500 in Scotland and Northern Ireland.

MS is a degenerative disease in which the immune system attacks the central nervous system. Professor Bentham said sunlight had the effect of suppressing the immune system, but he believed ultraviolet light stimulating the production of vitamin D was the probable protective element. People on the west coasts of Norway and Iceland, who ate oily fish such as herring and salmon, which were rich in vitamin D, had lower MS rates than populations in similar northern climes. "It is the vitamin D that is the key. If the body has enough then it protects against MS. More work is needed but it looks as if this could become an important method of preventing the disease."

Fellow researcher Andy Jones, a lecturer in environmental science, looked at blood pressure, which causes heart problems and strokes. People living near the equator had considerably lower blood pressure than those in temperate regions. Again he believed that vitamin D production caused by sunlight was responsible for the difference.

One of the key factors again was diet. Stone age man evolved in sunny places and had a high calcium intake because of the meat and raw plants that he ate. With modern eating habits, vitamin D was used by the body to absorb more calcium and avoid any deficiency.

When there was a shortage of vitamin D the body produced parathyroid hormone, which caused increased blood pressure. His theory was backed by research which showed that nurses who took calcium supplements had a 25% reduction in heart disease.

Both men were reluctant to reverse advice against sunbathing, with its risk of skin cancer. Dr Jones said: "We are talking about an incremental benefit on sunlight over years, not one big hit lying on a beach. That is much more likely to give you skin cancer and kill you in the long run while only giving you a small temporary benefit of vitamin D."

Lorna Layward, head of research at the MS Society, said the difference in the number of cases between north and south latitudes was well known but the cause had never been established. "This is very interesting but we need more research to find the direct cause."

05 Jan 01 - Medicine - New antibiotic 'kills superbugs'

Staff Reporter

Evening Standard - Friday 5 January 2001

Scientists have successfully tested what could be a decisive new weapon against drug-resistant bacteria , it was disclosed today.

Linezolid , the first of a new class of antibiotic, attacks bugs in a different way from traditional antibiotics.

A study of patients in the US has shown it is even more effective against bacteria that cause skin and soft tissue infections than a "gold standard" antibiotic drug.

It also caused only mild to moderate side effects, and could be swallowed as well as injected.

Test-tube studies had already suggested that Linezolid may kill or neutralise "superbugs" such as Methicillin-Resistant Staphylococcus Aureus (MRSA) which is causing an epidemic of post-operative infections in hospitals.

It also appears to be effective against bacteria resistant to Vancomycin, the current "last bullet" in the antibiotic arsenal.

In the tests, led by Dr Dennis Stevens of the University of Washington, Linezolid was given to patients with severe cellulitis, abscesses and wound infections, and compared with a tried and trusted antibiotic.

The new drug cured 88.6 per cent of 298 patients, while the old one successfully treated 85.8 per cent of 302 patients.

Dr Stevens said more research was needed, but added: "We haven't had any totally new antibiotics in a long time. It's a new cannon in our arsenal."